Who Is It For?

chapter 51 pharm 343 Flashcards Preview

*diphenoxylate with atropine (lomotil, lonox)

synthetic opiate agonist that is related to meperidine. it acts on smooth muscle of the intestinal tract, inhibiting GI motility and GI propulsion. it has no analgesic activity. when taken in large doses can cause extreme anticholinergic effects.(dry mouth, tummy pain, high heart rate, and blurred vision)

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*docusate salts (calcium and sodium) (colace)

stool softening emollient laxatives that help the passage of water and fats into the fecal mass which loosens stool. used to treat constipation, soften fecal impactions, and help with hemorrhoids and anorectal conditions. they do not cause defecation to ease its passage.

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*glycerin

promotes bowel movement by increasing osmotic pressure in intestine which draws fluid into the colon. often used in children. similar to sorbitol. contraindicated with pts with hypersensitivity reaction to it. rectal solution and suppository.

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*lactulose

synthetic derivative of natural sugar lactose which not digested in stomach or absorbed in small bowel. it passes unchanged into large intestine where it is metabolized. colonic bacteria digest lactulose to produce lactic acid, formic acid and acetic acid which creates a hyperosmotic environment that draws water into colon and produce laxative effect. reduces blood ammonia levels. ammonium is a water soluble cation that is trapped in intestines and cant be reabsorbed. oral or rectal use.

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*loperamide (Imodium (A-D))

synthetic antidiarrheal. it inhibits both peristalsis in the intestinal wall and secretion and decreasing the number of stools and water content. Opiate drug in OTC medication, contraindicated with severe ulcerative colitis, pseudomembranous colitis, and diarrhea from E.coli.

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*psyllium (metamucil)

natural bulkforming laxatives obtained from dried seed . contraindicated in pts with intestinal obsrtuction or fecal impaction. used for abdominal pain, nausea, and vomiting. oral use in wafer and powder form.

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*senna (senokot)

used OTC stimulant laxative. used for relief for acute constipation or bowel procedures. may cause abdomen pain. complete emptying in 6-12 hrs. tablets, syrup, and granules.

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Antidiarrheal drugs

drugs that counter or combat diarrhea.adsorbents, antimotility drugs and probiotics.

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IBS

a recurring condition of the intestinal tract characterized by bloating, flatulence, and often periods of diarrhea that alternate with constipation. women more effected

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laxatives

drugs that promote bowel evacuation, such as by increasing the bulk of the feces, softening the stool, or lubricating the intestinal wall. laxatives are among the most misused OTC meds. long-term and inappropriate use may result in laxative dependence, produce damage to bowel, or lead to nonexistent intestinal problems. not to be used for long period use. five major groups: bulk forming, emollient, hyperosmotic, saline, and stimulant laxatives.

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constipation

a condition of abnormally infrequent and difficult passage of feces through the lower gastrointestinal tract. constipation is a symptom not a disease. it is a disorder of movement thru the colon and/or rectum that can be caused by a variety of diseases or drugs.

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Adsorbents

Adsorbents act by coating the walls of GI tract. they bind the causative bacteria or toxin to their adsorbent surface for elimination through stool. Adsorbent bismuth subsalicylate is aspirin form and it also may have the same drug effects. charcoal coating also works with overdose cuz of the drug-binding effect. colestipol and cholestyramine are anion echange resin that are prescubed as antidiarrheal. antocholenergic drugs use to slow peristalsis by reducing the contractions and smooth muscle tone of GI tract and reduce GI secretions.

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diarrhea

the abnormally frequent passage of loose stools.5-8 million deaths per year in infants, small children and are among the leading causes of death and morbidity in underdeveloped nations. acute diarrhea-to sudden onset lasts from 3days-2weeks and is self-limiting. causes are drugs, bacteria, viruses, nutritional factors, and protozoa. chronic diarrhea-lasts longer than 3-4weeks and is associated with recurrent diarrheal stools, fever, nausea, vomiting, weight reduction (cachexia) and chronic weakness. causes include tumors, AIDS, diabetes, hyperthyroidism, Addison's disease, and IBS. treatment is to stop the stool frequency, replenishing fluids and elect, and preventing weight loss. pt with diarrhea should not take antidiarrheal meds bcuz it will cause organism to stay in body longer.

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GI disease symptoms

pain, nausea, vomiting, and diarrhea.

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Probiotics

poducts from bacterial cultures which make up normal bacterial flora. destroyed by antibiotics. work by replenishing these bacteria which helps balance of normal flora and suppress the growth of diarrhea causing bacteria. (yogurt)

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opiates in diarrhea

treatment is to reduce bowel motility. reduction of the pain associated with diarrhea by relief of spasms. increases water absorptions, electrolytes, and other nutrients from the bowel and reduce stool frequency and net volume.

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interactions antidiarrheal

treatment of diarrhea of various types and levels. adsorbents used in more mild cases. anticholenergic and opiates in more severe cases. probiotics for more with antibiotic-induced diarrhea.

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contraindications of antidiarrheal

major cute GI condition, intestinal obstruction or colitis.

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adverse effects of antidiarrheal

probiotics dont have any adverse effects.

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interactions of antidiarrheal

many drugs are absorbed from the intestines into the blood and delivered to sites. some antidiarrheal will alter this process. the adsorbents can decrease the effectiveness of many drugs by decreasing the absorption of certain drugs. anticoagulants cause bleeding and bruising when coadministered with adsorbents. the therpeutic effects can be caused by coadministeration with antacids. the opiates antidiarrheal can have CNS depressants id they are given with CNS depressants, alcohol, opioids, sedative-hypnotics, antipsychotics, or muscle relaxants. Bismuth sub can lead to increased bleeding times and bruising when administered with blood thinners and other nonsteroidal antiinflammatory drugs. can cause confusion in older adults.

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GI responsible for:

ingestion of dietary intake, digestion of intake into basic nutrients, absorption of basic nutrients, and storage and removal of fecal during defecation. ingestion->digestion->absorption->storage and removal. 24-36 hrs from ingestion and defecation.

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large intestine use

forming the stool by removing water from the fecal, temporarily storing the stool until defecation, and extracting essential vitamins from the intestinal bacteria (vitamin k). colon is 120-150cm long and is separated from the small intestine by ileocecal valve.

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constipation treatment is determined by:

age, concerns, and expectations, duration and severity and potential factors. either surgical or nonsurgical. nonsurgical-dietary, behavioral, and pharmacologic.

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mechanism of action of laxatives

bulk forming

bulk forming laxatives act in a manner similar to fiber naturally contained in diet. they absorb h2o into intestine which increase bulk and distends the bowel to initiate reflex activity and bowel movement.

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emollient

stool softener and lubricant laxatives softeners work by lowering the surface tension of GI fluids so that more h2o and fat are absorbed into the stool and intestines. the lubricant type works by lubricatin the fecal and the wall and preventing absorption of h2o from intestines. this h2o in the bowel softens and expands the stool. promotes bowel distention and reflex peristaltic actions lead o defecation.

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hyperosmotic laxatives

work by increasing fecal water content which results in distention increased peristalsis and evacuation. site of action is large intestine. saline laxatives increase osmotic pressure in small intestine by inhibiting h2o absorption and increasing both h2o and electrolyte secretions from the bowel wall into the lumen. watery stool increased distention promotes peristalsis and evacuation.

contraindications laxatives

adverse effects laxatives

are usually confined to intestines.

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interactions laxatives

alter intestinal function. they may be altered by drugs bcuz drugs are absorbed in intestines. bulk forming can decrease the absorption of antibiotics, warfarin, and digoxin. mineral oil can decrease fat soluble vitamins. hyperosmotic can cause increased CNS depression if they are given with barbs, general anesthesia, opioids, or antipsychotics.